Catheter with distal and proximal fixation members

ABSTRACT

A deflectable catheter includes an elongate member having a wall defining a longitudinally extending lumen extending from a proximal end to a distal end, a fixation member coupled to an exterior surface of the wall on a distal portion of the elongate member, and a pull wire extending through the wall of the elongate member from the proximal end of the elongate member to the fixation member. The pull wire is coupled to the fixation member and constrained along its length such that the elongate member is configured to deflect from an initial configuration to a deflected configuration in response to a pull force applied to the pull wire and actively return from the deflected configuration to the initial configuration in response to a push force applied to the pull wire.

This application claims the benefit of U.S. Provisional Application Ser.No. 62/874,078, entitled “CATHETER WITH DISTAL AND PROXIMAL FIXATIONMEMBERS,” and filed on Jul. 15, 2019, the entire content of which isincorporated herein by reference.

TECHNICAL FIELD

This disclosure relates to medical systems and techniques includingdeflectable shaft catheters.

BACKGROUND

Interventional medicine techniques may use deflectable shaft cathetersto deliver medical therapy and/or provide medical monitoring. Typically,a deflectable shaft catheter includes a pull wire extending along alength thereof, where a distal end of the pull wire is anchored to apull band on the shaft at a location just distal to a deflectablesegment of the shaft. A proximal end of the pull wire is typicallysecured to a control member subassembly mounted in a handle of thecatheter.

SUMMARY

The present disclosure describes example medical systems includingdeflectable catheters and techniques including the use and manufactureof deflectable catheters. The described deflectable catheters include apull wire that may have an overmolded distal end, an overmolded proximalend, or both. Components of the overmolded distal and/or proximal endmay provide a channel for the pull wire that is substantially leak-freeand enables a push force to be applied to the pull wire (e.g., by acontrol member). For example, when grasping the catheter handle, aclinician may actuate the pull wire by applying a force to the controlmember, thereby deflecting the catheter shaft from an initial (e.g.,substantially straight) configuration to a deflected (e.g., curved orotherwise bent) configuration. The deflected configuration may enable aclinician to maneuver a distal portion of the shaft toward a target sitewithin a body of a patient. Upon releasing the control member, oractively returning the control member to a home position, the pull wiremay actively apply a push force from the control member to the distalend of the catheter shaft to return the catheter shaft to the initialconfiguration.

In some examples, a catheter may include an elongate member, a fixationmember, and a pull wire. The elongate member may extend from a proximalend to a distal end, where the elongate member includes a wall defininga longitudinally extending lumen. The fixation member may be coupled toan exterior surface of the wall on a distal portion of the elongatemember. The pull wire may extend through the wall of the elongate memberfrom the proximal end of the elongate member to the fixation member. Thepull wire may be coupled to the fixation member. The elongate member maybe configured to deflect from an initial configuration to a deflectedconfiguration in response to a pull force applied to the pull wire.

In some examples, a catheter may include an elongate member extendingfrom a proximal end to a distal end, the elongate member including awall defining a longitudinally extending lumen; a distal fixation membercoupled to an exterior surface of the wall on a distal portion of theelongate member; a proximal fixation member coupled to an exteriorsurface of the wall on a proximal portion of the elongate member; aretention arm integrally formed with the proximal fixation member, wherethe retention arm may be configured to retain the pull wire in slidingengagement at an angle extending away from a longitudinal axis of theelongate member; a pull wire extending from a distal end coupled to thedistal fixation member, through the wall of the elongate member, to adistal portion extending through the proximal fixation member andretention arm, and wherein the elongate member is configured to deflectfrom an initial configuration to a deflected configuration in responseto a pull force applied to the pull wire.

In some examples, a method may include forming an elongate memberextending from a proximal end to a distal end, the elongate memberincluding a wall defining a longitudinally extending lumen. The methodalso may include overmolding a fixation member onto an exterior surfaceof the wall on a distal portion of the elongate member. The method alsomay include anchoring a pull wire to the fixation member, the pull wireextending through the wall of the elongate member from the proximal endof the elongate member to the fixation member, and the elongate memberconfigured to deflect from an initial configuration to a deflectedconfiguration in response to a pull force applied to the pull wire.

The details of one or more examples are set forth in the accompanyingdrawings and the description below. Other features, objects, andadvantages will be apparent from the description and drawings, and fromthe claims.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a schematic and conceptual diagram illustrating a plan view ofan example deflectable catheter.

FIGS. 2A-2C are conceptual diagrams illustrating lateral and axialcross-sectional views of an example catheter.

FIGS. 3A and 3B are conceptual diagrams illustrating an example distalfixation member on a distal end of an elongate member of an examplecatheter.

FIG. 4 is a conceptual and schematic diagram illustrating differentconfigurations of distal ends of pull wires of respective examplecatheters.

FIGS. 5A-5D are conceptual and schematic diagrams illustrating a distalcup coupled to a distal end of an elongate member of an examplecatheter.

FIG. 6 is a conceptual diagram illustrating a proximal fixation memberon a proximal end of an elongate member of an example catheter.

FIGS. 7A and 7B are conceptual diagram illustrating an example mold diefor overmolding the proximal fixation member illustrated in FIG. 6 on toan example catheter.

FIGS. 8A-8C are conceptual diagrams illustrating an example hub assemblyand an example reveal surround of a catheter.

FIGS. 9A-9F are conceptual diagrams illustrating an example handle of adeflection assembly of a catheter.

FIGS. 10A-10C are conceptual diagrams illustrating an exampledeflectable catheter having deflection assembly including a dampeningmember.

FIG. 11 is a flow diagram illustrating an example method ofmanufacturing an elongate member of a deflectable catheter.

FIG. 12 is a flow diagram illustrating an example method ofmanufacturing a deflectable assembly of a deflectable catheter.

FIG. 13 is a flow diagram illustrating an example method of using adeflectable catheter.

DETAILED DESCRIPTION

The disclosure describes example medical systems including deflectablecatheters and techniques including the use and manufacture ofdeflectable catheters. An example deflectable catheter includes anelongate member and a deflection assembly. The deflection assemblyincludes a handle, an elongate pull wire, and a control member. Theelongate member includes a wall extending from a proximal end to adistal end and defining a longitudinally extending lumen. The proximalend of the elongate member may be coupled to a handle of the deflectionassembly. The elongate pull wire of the deflection assembly extends froma fixation member at a distal portion of the elongate member to thecontrol member, e.g., through at least a portion of the wall of theelongate member.

When a clinician slides the control member proximally the distal portionof the elongate member may deflect from an initial configuration to adeflected configuration. When the clinician releases the control memberor pushes the control member back distally to the home position, thepull wire actively pushes the elongate member back to the initialconfiguration. For example, a perimeter of the pull wire may beconstrained from the fixation member at the distal portion of theelongate member to the control member. By constraining the pull wire, apush force applied to the pull wire may be translated from the controlmember to the distal portion of the elongate member, rather than, anunconstrained pull wire bending or buckling in response to a push force.Translation of the push force by the constrained pull wire enablesactive return of the elongate member from a deflected configuration toits initial configuration, which may be a substantially straightconfiguration.

By enabling active return using a single pull wire, the describeddeflectable catheters provide enhanced function compared to deflectablecatheters without active return. For example, a deflectable catheterwithout active return, upon release of a control member of when in adeflected configuration, may relax toward the initial configuration dueto release of strain in the elongate member. In some examples, thereturn to initial configuration may be due to elastic deformation of atleast a portion of the elongate member. In some examples, thedeflectable catheter without active return may be unable to fully returnto the initial configuration, for example, due to plastic deformation ofat least a portion of the elongate member. An active return deflectablecatheter, however, may be controlled to return to the initialconfiguration. In some examples, an active return deflectable cathetermay extend beyond the initial configuration, e.g., deflect in a seconddirection opposite the deflected configuration.

FIG. 1 is a schematic and conceptual diagram illustrating a plan view ofan example deflectable catheter 100. Deflectable catheter 100 includesan elongate member 102 and a deflection assembly 104. Elongate member102 extends from a proximal end 106 to a distal end 108. Elongate member102 includes a wall 110 defining a longitudinally extending lumen (notshown).

Wall 110 may include one or more material layers. For example, wall 110may include one or more polymeric material layers. In some examples,wall 110 may include an elongate core layer, an inner layer, and anouter layer. The elongate core layer may include a substantiallyresilient material, e.g., relative to the inner layer and/or outerlayer. In some examples, elongate core layer may include a coiled orbraided metal wire, such as, for example, stainless steel or nitinol,defining an exterior surface and an interior surface defining the lumenof elongate member 102. The inner layer may include a polymer, such as,for example, polytetrafluoroethylene or other polymer having a lowcoefficient of friction (e.g., relative to the elongate core layer),disposed on the interior surface of the elongate core layer. The outerlayer may include a polymer, such as, for example, polyether block amideor other flexible polymers, disposed on the exterior surface of theelongate core layer.

Proximal portion (e.g., proximal end 106) of elongate member 102 iscoupled to deflection assembly 104. Deflection assembly 104 includes ahub assembly (not shown), a handle 112, a control member 114, and a pullwire 126. The hub assembly may be coupled to at least a portion ofproximal portion 120 (e.g., proximal end 106) of elongate member 102.For example, the hub assembly may be overmolded onto the portion ofproximal portion 120 of elongate member 102. Handle 112 may beconfigured to surround and engage at least a portion of the hubassembly. Additionally, or alternatively, at least a portion of proximalportion 120 (e.g., proximal end 106) of elongate member 102 may becoupled directly to handle 112. Control member 114 may be slidablyengaged with handle 112. For example, handle 112 may define track 128,along which control member 114 may move (e.g., in the proximal-distaldirection).

Pull wire 126 extends from a proximal end 130 to a distal end 132.Proximal end 130 of pull wire 126 may be coupled to control member 114.In some examples, deflection assembly 104 may include a hypotube (notshown) extending from a distal end of the hypotube directly coupled toproximal end 130 of pull wire 126 to a proximal end of the hypotubedirectly coupled to control member 114. Pull wire 126 may extendthrough, for example, at least a portion of the hub assembly, handle112, and/or wall 110 of elongate member 102. For example, handle 112 mayinclude a handle surround (not shown) configured to surround at least aportion of pull wire 126 and/or the hypotube extending from the hubassembly to control member 114. Pull wire 126 may include any suitableinextensible and/or incompressible material. In some examples, pull wire126 may include a metal, such as, stainless steel or nitinol, formedinto an elongate wire, coil, or braid.

Distal end 132 of pull wire 126 may be coupled (e.g., anchored) to afixation member 122. Fixation member 122 may be coupled to an exteriorsurface 124 of wall 110 on distal portion 116 of elongate member 102.For example, fixation member 122 may include one or more componentsconfigured to mechanically couple pull wire 126 to distal portion 116 ofelongate member 102. In some examples, fixation member 122 may include aferrule, a collet, a compression fitting, or any suitable annularfitting overmolded or mechanically coupled (e.g., adhered or frictionfit) to exterior surface 124 of wall 110 of elongate member 102. In thisway, fixation member 122 may be configured to engage exterior surface124 of wall 110 of elongate member 102. In some examples, fixationmember 122 also may include a channel or a protrusion configured toreceive distal portion 132 of pull wire 126. In some examples, distalend 132 of pull wire 126 may include an anchor, such as a bulbousstructure (e.g., having a diameter larger than a diameter of pull wire126), a washer, a loop, or a knot, to enable fixation member 122 tosecurely retain distal portion 132 of pull wire 126.

In some examples, distal portion 116 (e.g., distal end 108) of catheter100 may include a distal cup 134. Distal cup 134 may extend fromfixation member 122 to distal tip 136. Distal cup 134 may be configuredto encase at least a portion of fixation member 122. For example, distalcup 134 may be overmolded onto at least a portion of fixation member 122and/or distal end 132 of elongate pull wire 126. In some examples,distal cup 134 may include any suitable material, such as one or morepolymers. At least one of a tensile strength of the one or more polymersof distal cup 134 may be greater than a tensile strength of a materialof elongate member 102 or a durometer of the one or more polymers ofdistal cup 134 may be greater than a durometer of the material ofelongate member 102. In this way, distal cup 134 may include a polymermaterial that is tougher than an outer layer of elongate member 102. Therelative toughness of distal cup 134 may improve the robustness ofpulling and pushing on pull wire 126, for example, compared to anattachment of a pull wire directly to elongate member 126 or an anchorband embedded in elongate member 126.

In some examples, distal cup 134 may be configured to receive animplantable medical device (IMD). For example, distal cup 134 may beconfigured to receive an implantable electrical therapy device, such asa cardiac pacing device. In some examples, distal cup 134 may beconfigured to deploy the 1 MB. For example, a clinician may introducedistal portion 116 of elongate member 202 into vasculature of a patient.The clinician may guide distal cup 134 to a target site within thevasculature of a patient. The target site may include, for example, atarget pacing site. Once positioned at the target site, the clinicianmay deploy the 1 MB from distal tip 136 of distal cup 134. For example,deflectable catheter 100 may include any suitable deployment memberconfigured to deploy the IMD from distal tip 136 of distal cup 134. Insome examples, the deployment member may include a control wire having aproximal end coupled to a control member at deflection assembly 104, amedial portion extending through elongate member 102, and a distal endconfigured to push IMD out of distal cup 134.

At least a portion of a distal portion 116 of elongate member 102 isconfigured to deflect, e.g., in the direction of arrow 118, from aninitial configuration (e.g., shown as solid lines in FIG. 1 ) to adeflected configuration (e.g., shown as dashed lines in FIG. 1 ).Proximal portion 120 of elongate member 102 may be configured to notdeflect when distal portion 116 is deflected. When a clinician slidescontrol member 114 proximally, as indicated by arrow 138, the distalportion of elongate member 102 may deflect from the initialconfiguration to the deflected configuration. In some examples, theinitial configuration may include a substantially straightconfiguration, e.g., a straight or nearly straight configuration ofelongate member 102. In some examples, the initial configuration mayinclude a bent configuration, e.g., elongate member 102 may define acurve or bend when in a relaxed state without application of a pullforce or push force. In some examples, the deflected configuration mayinclude any suitable deflection relative to the initial configuration.

In some examples, the deflection occurs on the distal portion ofelongate member 102 because wall 110 of elongate member 102 is moreflexible or more compressible along distal portion 116 relative toproximal portion 120. Generally, the deflected configuration may includeany suitable arc degree and/or radius of curvature. In some examples,the arc degree of the deflected configuration may be within a range fromabout 10 degrees to about 180 degrees, such as from about 20 degree toabout 90 degrees. In some examples, the deflected configuration mayinclude two or more deflections in the same direction or differentdirections. The first and second deflections may be at the same ordifferent longitudinal position relative to elongate member 102. Forexample, the deflected configuration may include a first deflection(e.g., in the plane of the page as illustrated in FIG. 1 ) and a seconddeflection in a second direction at the same or a different longitudinalposition (e.g., out of the plane of the page as illustrated in FIG. 1 ).

When the clinician releases control member 114 or pushes the controlmember back distally to a home position, pull wire 126 actively pusheselongate member 102 back to the initial configuration. For example, aperimeter of pull wire 126 may be constrained (e.g., surrounded) fromfixation member 122 at distal end 108 of elongate member 102 to controlmember 114. By constraining pull wire 126, a push force applied to pullwire 126 may be transferred from control member 114 to distal portion116 of elongate member 102, rather than, an unconstrained pull wirebending or buckling in response to the push force. Transfer of the pushforce by the constrained pull wire 126 enables active return of elongatemember 102 from the deflected configuration to the initialconfiguration. By enabling active return using a single pull wire, thedescribed deflectable catheters provide enhanced function compared todeflectable catheters without active return. For example, a deflectablecatheter without active return, upon release of a control member when ina deflected configuration, may relax toward the initial configurationdue to release of strain or elastic deformation in the elongate member.In some examples, a deflectable catheter without active return may beunable to fully return to an initial configuration, for example, due toplastic deformation of at least a portion of the elongate member. Activereturn deflectable catheter 100, however, may be controlled to return tothe initial configuration, as described above.

In some examples, an active return deflectable catheter may extendbeyond the initial configuration, e.g., deflect in a second directionopposite the deflected configuration. In some examples, deflectionassembly 104 may include a dampening member configured to dampen a forceapplied to control member 114 in a distal direction, a proximaldirection, or both. In this way, a clinician may move the control memberback distally to the home position while the elongate member activelyreturns at a slightly dampened rate to the initial configuration. Insome examples, the dampening member may include a spring positionedwithin the handle and mechanically coupled to the control member suchthat when the control member is pulled proximally the spring is notengaged (under compression or tension), but when the control member ispushed distally the spring is engaged under compression (e.g. to act asa shock absorber). In some examples, the spring also may provide forsome active straightening.

FIGS. 2A and 2B are conceptual diagrams illustrating lateral and axialcross-sectional views of an example catheter 200. Catheter 200 may bethe same as or substantially similar to deflectable catheter 100describe above in reference to FIG. 1 , except for the differencesdescribed herein. Catheter 200 includes elongate member 202, distalfixation member 204, proximal fixation member 206, and pull wire 208.Distal fixation member 204 and proximal fixation member 206 areconfigured to enable overmolding of a cup at the distal end of catheter200 and a hub at the proximal end of catheter 200. For example, withoutdistal fixation member 204 and proximal fixation member 206 overmoldingthe cup and the hub onto catheter 200 may compress or deform catheter200. In some examples, distal fixation member 204 and proximal fixationmember 206 may be overmolded onto catheter 200 using less pressurerelative to a high pressure overmolding of the cup and the hub. In someexamples, proximal fixation member 206 may include a ferrule thatenables overmolding pull wire 208 (or sacrificial wire), such that thewire can extend out of the overmolding mold without the overmoldmaterial being expelled from the mold.

Elongate member 202 extends from proximal end 210 to distal end 212. Asdiscussed above, elongate member 202 may be configured to deflect froman initial configuration to a deflected configuration in response to apull force applied to pull wire 208 (e.g., in the proximal direction)and actively return from the deflected configuration to the initialconfiguration in response to a push force applied to pull wire 208(e.g., in the distal direction). Elongate member includes wall 214defining a longitudinally extending lumen 216. Wall 214 may include anelongate core layer 218, inner layer 224, and exterior layer 226, asdiscussed above. Elongate core layer 218 defines an exterior surface 220and an interior surface 222. Interior surface 222 may definelongitudinally extending lumen 216. Inner layer 224 may be disposed oninterior surface 222 of elongate core layer 218. Outer layer 226 may bedisposed on exterior surface 220 of elongate core layer 218. In someexamples, pull wire 208 may extend through inner layer 224 from proximalend 210 to distal end 212 of elongate member 202. In some examples, pullwire 208 may extend through a separate dedicated lumen between innerlayer 224 and core layer 218. In some examples, pull wire 208 may extendthrough both proximal fixation member 206 and distal fixation member204.

Distal fixation member 204 is coupled to an exterior surface 228 of wall214 on a distal portion 230 of elongate member 202. Distal fixationmember 204 may include at least one of a ferrule or a collet configuredto engage exterior surface 228 by at least one of a friction fit, acompression fit, or another mechanical fitting, such as by adhesion orovermolding. Distal fixation member 204 is configured to couple todistal end 232 of pull wire 208. For example, distal fixation member 204may define a distal fixation channel 234 through which pull wire 208 mayextend in sliding engagement. In some examples, distal end 232 of pullwire 208 may defined or include a bulbous structure (e.g., a structurehaving a diameter larger than a diameter of pull wire 208), a washer, aloop, or a knot. In this way, when a pull force is applied to pull wire208 (e.g., in the proximal direction), distal end 232 may transfer thepull force to distal fixation member 204 and elongate member 202. Insome examples, a distal cup (e.g., distal cup 134) may be coupled todistal fixation member 204 and distal end 232 of pull wire 208. Thedistal cup may be configured to, when a push force is applied to pullwire 208 (e.g., in the distal direction), transfer the push force fromdistal end 232 to the distal cup, distal fixation member 204, andelongate member 202. In this way, the distal end of catheter 200 isconfigured to transfer both a push force and pull force via a singlepull wire 208 for deflection and active return of elongate member 202.

Proximal fixation member 206 is coupled to exterior surface 228 of wall214 of elongate member 202 on a proximal portion 236 (e.g., proximal end238) of elongate member 202. Proximal fixation member 206 may include atleast one of a ferrule or a collet configured to engage exterior surface228 of wall 214 of elongate member 202 by at least one of a frictionfit, a compression fit, or another mechanical fitting, such as byadhesion or overmolding. Proximal fixation member 206 may be configuredto retain pull wire 208 in sliding engagement. For example, proximalfixation member 206 may define a proximal retention channel 240configured to retain pull wire 208 in sliding engagement. In someexamples, proximal fixation member 206 may be configured to deflect pullwire 208 away from longitudinal axis 242, e.g., along which elongatemember 202 extends. For example, proximal fixation member 206 mayinclude a retention arm 244 extending from proximal fixation member 206(e.g., the ferrule or the collet of proximal fixation member 206).Retention arm 244 may be integrally formed with proximal fixation member206 or fixed to proximal fixation member 206 by, for example, anadhesive. Retention arm 244 may include a retention channel 246extending from a distal end 248 to a proximal end 250 thereof at anangle θ relative to longitudinal axis 242 of elongate member 202. Insome examples, proximal end 250 may define a ferrule. Retention channel246 may be configured to retain pull wire 208 in sliding engagement. Inthis way, proximal fixation member 206 may orient pull wire 208 awayfrom elongate member 202 such that a proximal end of pull wire 208 maybe coupled to a control member of a deflection assembly (e.g., controlmember 114 of deflection assembly 104).

In some examples, proximal fixation member 206 also may include a revealsurround 252. In some examples, the reveal 252 is not attached toproximal end 250. For example, proximal end 250 may include a ferrule,such that both proximal end ferrule 250 and reveal 252 may be placed ina mold for overmolding. As a hub is overmolded onto proximal fixationmember 206, reveal 252 may allow proximal end ferrule 250 to seal (e.g.,such that the overmold material is not expelled from the mold) whilepull wire 208 (or sacrificial wire) can extend through an aperture ofthe mold. After the overmolded proximal fixation member 206 cools, thesacrificial wire may be pulled out leaving retention channel 246. Thefinal pull wire 208, in some examples having a smaller diameter than thesacrificial wire, may be inserted through the distal end of catheter 200and out reveal 252. Alternately, the reveal surround 252 may couple toretention arm 244, for example, by a mechanical interlock or anadhesive. Reveal surround 252 may include a reveal surround channel 254.Reveal surround channel 254 may extend from a distal end to a proximalend thereof at angle θ relative to longitudinal axis 242 of elongatemember 202. In other examples, reveal surround channel 254 may extend atan angle different than that of retention arm channel 246. Revealsurround 252 may be configured to retain pull wire 208 in slidingengagement. Reveal surround may enable a hub assembly to be overmoldedonto catheter 100 such that pull wire 208 is fluidically isolated fromlumen 216. In this way, catheter 200 may include a leak resistant orleak proof pull wire assembly.

Distal fixation member 204 and proximal fixation member 206 may includeany suitable material. In some examples, distal fixation member 204and/or proximal fixation member 206 may include a heat moldable polymer.For example, distal fixation member 204 and/or proximal fixation member206 may be overmolded onto a respective distal portion 230 or proximalportion 236 of elongate member 202. In some examples, distal fixationmember 204 and/or proximal fixation member 206 may be overmolded aroundpull wire 208 or around a sacrificial wire that may be replaced withpull wire 208 after overmolding proximal fixation member 206.

Pull wire 208 may be the same as or substantially similar to pull wire126 discussed above in reference to FIG. 1 . For example, pull wire 208extends through wall 214 of elongate member 202 from proximal end 238 ofelongate member 202 to distal fixation member 204, and pull wire 208 maybe coupled to distal fixation member 204. Pull wire 208 may extendthrough inner layer 224 or be disposed between inner layer 224 and corelayer 218. In some examples, as illustrated in FIG. 2C, pull wire 208may protrude through outer layer 226 at proximal end 238 of elongatemember 202. In other examples, as illustrated in FIG. 2C, pull wire 208may protrude through core layer 218 and outer layer 226 to exteriorsurface 228 of wall 214 at proximal portion 236 of elongate member 202(e.g., at a location distal to proximal end 238 of elongate member 202).In some examples, pull wire 208 may include a sheath or tube surroundingat least a portion of pull wire 208.

FIGS. 3A and 3B are conceptual diagrams illustrating an example distalfixation member 306 on a distal end 304 of an elongate member 302 of anexample catheter 300. Catheter 300 may be the same as or substantiallysimilar to catheters 100 and 200 discussed above in reference to FIGS.1-2B. Distal fixation member 306 is coupled to distal portion 308 ofelongate body 302, as discussed above. Distal fixation member 306includes a fixation arm 310 to which pull wire 312 may be coupled. Forexample, pull wire 312 includes two loops surrounding a portion offixation arm 310. In some examples, at least a distal portion of pullwire 312 may be encased in fixation arm 310, e.g., distal fixationmember 306 may be overmolded over at least a distal portion of pull wire312. By surrounding the portion of fixation arm 310, pull wire 312 maytransfer a pull force and/or a push force to fixation member 306 andelongate member 302, as discussed above in reference to FIGS. 1-2B.

FIG. 4 is a conceptual and schematic diagram illustrating differentconfigurations of distal ends 410A, 410B, 410C, and 410D of respectivepull wires 408A, 408B, 408C, and 408D protruding from respective distalends 406A, 406B, 406C, and 406D of respective walls of respectiveelongate members 402A, 402B, 402C, and 402D of respective catheters400A, 400B, 400C, and 400D (collectively, “catheters 400”). Catheters400 may be the same as or substantially similar to any one or more ofcatheters 100, 200, and 300 discussed above in reference to FIGS. 1-3B.As illustrated in FIG. 4 , distal end 410A includes a double loop havinga centroid substantially aligned with an axis of pull wire 408A. Distalend 410B includes an overhand knot. In other example, distal end mayinclude other types of knots. Distal end 410C includes a double loophaving a centroid displaced from an axis of pull wire 408C. Distal end410D includes bulbous structure, such as a bead of metal weld, and awasher. Any of the distal ends 410 of pull wires 408 may also contain aweld or adhesive to enhance strength. As discussed above, distal ends410A, 410B, 410C, and 410D are configured to engage a fixation memberand/or a distal cup (e.g., a portion of an overmolded distal cup) toenable respective pull wires 408A, 408B, 408C, and 408D to transfer apush force and/or a pull force to respective elongate members 402A,402B, 402C, and 402D.

FIGS. 5A-5D are conceptual and schematic diagrams illustrating a distalcup 504 coupled to a distal end 506 of an elongate member 502 of anexample catheter 500. For purposes of illustration, distal cup 504 isillustrated as a transparent polymer and, in FIGS. 5C and 5D, with apartial cut away. As shown in FIG. 5A, a reference numeral 501 indicatesa portion of catheter 500 illustrated in greater detail by FIG. 5B. Asshown in FIG. 5C, a reference numberal 503 indicates a portion ofcatheter 500 illustrated in greater detail in FIG. 5D. Catheter 500 maybe the same as or substantially similar to any one or more of catheters100, 200, 300, and 400 discussed above in reference to FIGS. 1-4 . Forexample, distal cup 504 may be configured to receive implantable medicaldevice 512. In some examples, distal cup 504 may be overmolded ontodistal fixation member 508 and distal end 506 of elongate member 502. Byovermolding distal cup 504 onto distal fixation member 508 and distalend 506 of elongate member 502, distal cup 504 may encase fixation arm510 of distal fixation member 508 to securely retain distal end 514 ofpull wire 516. Securely retaining distal end 514 of pull wire 516 mayenable pull wire 516 to transfer a push force and/or a pull for toelongate member 502.

FIG. 6 is a conceptual diagram illustrating a proximal fixation member606 on a proximal end 604 of an elongate member 602 of an examplecatheter 600. Catheter 600 may be the same as or substantially similarto any one or more of catheters 100, 200, 300, 400, 500 discussed abovein reference to FIGS. 1-5D. Proximal fixation member 606 is coupled toproximal end 604 of an elongate member 602, as discussed above. Proximalfixation member 606 may define a proximal retention channel configuredto retain pull wire 616 in sliding engagement and include a retentionarm 608. Retention arm 608 extends from proximal fixation member 606(e.g., the ferrule or the collet of proximal fixation member 206).Retention arm 608 may include a retention channel 610 extending from adistal end 612 to a proximal end 614 thereof at an angle relative to alongitudinal axis of elongate member 602. Retention channel 610 may beconfigured to retain pull wire 616 in sliding engagement. In this way,proximal fixation member 606 may orient pull wire 616 away from elongatemember 602 such that a proximal end of pull wire 208 may be coupled to acontrol member of a deflection assembly (e.g., control member 114 ofdeflection assembly 104).

As discussed above, in some examples, a distal fixation member and/or aproximal fixation member may be overmolded onto an elongate member overa pull wire. FIGS. 7A and 7B are conceptual diagrams illustrating anexample mold die 700 for overmolding a proximal fixation member 704,such as proximal fixation member 606 illustrated in FIG. 6 , onto anelongate member 702 of an example catheter 700. A first half of mold die700 is illustrated in FIGS. 7A and 7B. A second half of mold die (notshown) is configured to be coupled to the first half of mold die toovermold proximal fixation member 704 onto elongate member 702. Mold die700 may include a mold region 706 corresponding to a selected shape ofproximal fixation member 704 and one or more channels 708 configured todirect an injected flowable polymer into the mold. In some examples,mold die 700 may include a pin 710 configured to fit within the lumendefined by elongate member 702. Pin 710 may reduce deformation, such ascollapsing of the lumen, of elongate member 702 when a flowable polymeris injected into mold region 706. Mold die 700 also defines a pull wirechannel 712 configured to receive a pull wire extending from a proximalend of elongate member 702. Pull wire channel 712 may extend at an anglefrom a longitudinal axis of elongate member 702.

As discussed above, a catheter may include a reveal surround thatenables a hub assembly to be overmolded onto at least a portion ofproximal portion (e.g., proximal end) of an elongate member of thecatheter such that a pull wire of the catheter may be fluidicallyisolated from a lumen of the catheter. FIGS. 8A-8C are conceptualdiagrams illustrating an example hub assembly 802 and an example revealsurround 804 of a catheter 800. Catheter 800 may be the same as orsubstantially similar to any one or more of catheters 100, 200, 300,400, 500, 600, 700 discussed above in reference to FIGS. 1-7B. Hubassembly 802 may be overmolded onto proximal portion 806 of elongatemember 808. In some examples, a handle of a deflection assembly may beconfigured to surround and engage at least a portion of hub assembly802. Hub assembly 802 may define a lumen 810 fluidly coupled to a lumenof elongate member 808. In some examples, hub assembly 802 also maydefine a flush port 812.

In some examples, reveal surround 804 may be coupled to a proximalfixation member 814 (e.g., the proximal fixation member 814 beingcoupled to proximal end 806 of elongate member 808). For example, revealsurround 804 may couple to a retention arm of proximal fixation member814. As illustrated in FIG. 8B, reveal surround 804 may include a revealsurround channel 816 extending from distal end 822 to proximal end 824and an alignment aperture 823. Reveal surround channel 816 may beconfigured to retain pull wire 820 in sliding engagement and, when pullwire 820 is positioned within reveal surround channel 816, reduce orprevent passage of fluid through reveal surround channel 816. Alignmentaperture 823 may be used to align and secure reveal 804 duringovermolding. Additionally, or alternatively, when overmolding hub 802onto proximal fixation member 814, the hot overmold material connects tothe elongate member 808 and/or proximal fixation member 814, andsurrounds pull wire 820. When overmolding hub 802, the ferrule of theretention arm (e.g., proximal end ferrule 250) and reveal 804 mayprevent the hot overmold material from being expelled from the mold. Asillustrated in the magnified view of FIG. 8C, reveal surround channel816 may extend at angle θ relative to longitudinal axis 818 of elongatemember 808. Reveal surround 804 may enable hub assembly 802 to beovermolded onto proximal portion 806 of elongate member 808 such thatpull wire 808 is fluidically isolated from lumen 810. In this way,catheter 800 may include a leak resistant or leak proof pull wireassembly. In some examples, a sacrificial wire may be used duringmolding and then replaced with the final pull wire. This may aid inmanufacturing and enhance pull wire ease of movement.

As discussed above, a deflection assembly of a deflectable catheter mayinclude a handle configured to surround and engage at least a portion ofthe hub assembly and enable a clinician to manipulate the deflectablecatheter. FIGS. 9A-9F are conceptual diagrams illustrating an examplehandle 912 of a deflection assembly 904 of a catheter 900. As shown inFIG. 9C, a reference numberal 901 indicates a portion of catheter 900illustrated in greater detail FIG. 9D. As shown in FIG 9E, a referencenumeral 903 indicates a portion of catheter 900 illustrated in greaterdetail by FIG. 9F. Catheter 900 may be the same as or substantiallysimilar to any one or more of catheters 100, 200, 300, 400, 500, 600,700, 800 discussed above in reference to FIGS. 1-8C. As illustrated inFIGS. 9A and 9B, handle 912 may include a first portion 916 and a secondportion 918. First and second portions 916 and 918 of handle 912 areconfigured to mechanically couple to surround at least a portion of hubassembly 920. Deflection assembly 904 also includes control member 914.Control member 914 may be slidably engaged with handle 912. For example,handle 912 may define track 928, along which control member 914 may move(e.g., in the proximal-distal direction). In some examples, controlmember 914 may be coupled to pull wire 926 via pull block 941.

As illustrated in FIGS. 9C-9F, pull wire 926 may be coupled to controlmember 914 via hypotube 932 and pull block 941. For example, deflectionassembly 904 includes a hypotube 932 extending from a distal end 934 toa proximal end 936. As illustrated in FIG. 9F, pull wire 926 may extendinto or through a lumen 931 of hypotube 932. In some examples, hypotube932 may be crimped onto at least a portion of pull wire 926 tomechanically coupled hypotube 932 to pull wire 926. In some examples,distal end 934 of hypotube 932 may be directly coupled to a proximalportion (e.g., proximal end 930) of pull wire 926. In some examples,hypotube 932 may be bent at roughly 90 degrees to interface with thelongitudinally extending pull wire 926 and control member 914 whichtravels in the longitudinal direction along handle 912.

In some examples, hypotube 932 may be substantially rigid compared topull wire 926. For example, hypotube 932 may be sufficiently rigid suchthat, in response to a push force or a pull force applied by a clinicianto control member 914, hypotube 932 travels with control member 914 inthe proximal-distal direction rather than, for example, deflecting orbending in response to the pull force or push force. Hypotube 932include any suitable material, such as, for example, stainless steel,nitinol, or a medical grade alloy.

Proximal end 936 of hypotube 932 and/or proximal end 930 of pull wire926 may be directly coupled to pull block 941. Clearance pocket 940 ofcontrol member 914 may allow control member 914 to travel up and downindependent of hypotube 932. In this way, control member 914 is coupledto pull wire 926 to transfer a pull force and/or a push force tohypotube 932 and pull wire 926.

Handle 912 is formed to constrain pull wire 926 such that a push forceapplied to pull wire 926 by control member 914, e.g., via hypotube 932,is transferred along a longitudinal axis of pull wire 926 rather thancausing pull wire 926 to bend or kink. The constraint of pull wire 926may include a plurality of constraint regions. For example, asillustrated in FIG. 9F, a first constraint region 950 may include lumen931 of hypotube 932. As discussed above, hypotube 932 may be crimpedonto a portion of pull wire 926 to support pull wire 926 and enableproximal end 930 of pull wire 926 to be anchored to control member 914.A second constraint region 952 may include handle surround 954. Handlesurround 954 may include a channel or tunnel through which pull wire 926and/or hypotube 932 may freely travel. For example, first and secondportions 916 and 918 of handle 912 may be configured to mate to definehandle surround 952. A third constraint region 956 may include proximalfixation member 922 (e.g., including retention arm 923) and revealsurround 924. As discussed above, proximal fixation member 922 andreveal surround 924 may define at least a portion of an area betweenwhere pull wire 926 extends through wall 910 of the elongate member 902and connects to hypotube 932. For example, proximal fixation member 922may encase pull wire 926 from a point where pull wire 926 extendsthrough wall 910 of elongate body 902 to reveal surround 924. Revealsurround 924 may enable overmolding of hub assembly 920 and the pullwire to extend to the hypotube. In this way, first, second, and thirdconstraints 950, 952, and 956 enable active return of elongate tube 902.

In some examples, a deflection assembly of a deflectable catheter mayinclude a dampening member configured to dampen a force applied tocontrol member 114 in a distal direction, a proximal direction, or both.FIGS. 10A-10B are conceptual diagrams illustrating an exampledeflectable catheter 1000 having deflection assembly 1004 including adampening member 1060. Catheter 1000 may be the same as or substantiallysimilar to any one or more of catheters 100, 200, 300, 400, 500, 600,700, 800, 900 discussed above in reference to FIGS. 1-9F. As illustratedin the exploded view of FIG. 10A, deflection assembly 1004 includeshandle 1012, strain relief member 1013, control member 1014, hubassembly 1020, and dampening member 1060. Handle 1012 includes a firstportion 1016 and a second portion 1018 that are configured tomechanically couple to surround at least a portion of hub assembly 1020,e.g., to define a handle surround. Strain relief member 1013 may beconfigured to couple to first and second portions 1016 and 1018 ofhandle 1012 and to at least a portion of elongate member 1002 to enablehandle 1012 to transfer a movement of handle 1012 to elongate member1002, such as, for example, a torque or proximal-distal movement ofhandle 1012. As discussed above, handle 1012 may couple to hub assembly1020. Pull wire 1026 may be coupled to hypotube 1032, which isconfigured to couple to control member 1014.

Dampening member 1060 is configured to dampen a force applied to controlmember 1014 in a distal direction, a proximal direction, or both.Dampening member 1060 may include an outer pull block 1062, an innerpull block 1064, and a spring 1066. Outer pull block 1062 may beconfigured to couple to control member 1014. Outer pull block 1062 maybe in sliding engagement with track 1028 defined by handle 1012. Forexample, when a clinician moves control member 1014 in theproximal-distal direction, outer pull block 1062 may move with controlmember 1014 (e.g., the same direction and distance). Outer pull block1062 may define a track 1068 in sliding engagement with inner pull block1064. Inner pull block 1064 may be coupled to hypotube 1032 which iscoupled to pull wire 1026. As illustrated in FIG. 10B, when controlmember 1014 is moved in a proximal direction, a distal surface 1070 ofinner pull block 1064 may contact a distal wall 1072 of outer pull block1062. In this way, inner pull block 1064 may move with outer block 1062when control member 1014 is moved in a proximal direction. Asillustrated in FIG. 10C, when control member 1014 is moved in a distaldirection (e.g., active return), inner pull block 1064 may resistmovement relative to outer pull block 1062 such that movement of controlmember 1014 and outer pull block 1062 in the distal direction may resultin the compression of spring 1066. In this way, when control member 1014is pulled proximally spring 1066 is not engaged (under compression ortension), but when control member 1014 is pushed distally spring 1066 isengaged under compression (e.g., to act as a shock absorber). Once theforce of compression of spring 1066 is greater than the force requiredfor active return of elongate member 1002 (or once a proximal end ofinner pull block 1064 contacts a proximal wall of outer pull block 1062)a push force may be transferred from control member 1014 to outer pullbock 1062, through spring 1066 and inner pull block 1064 to hypotube1032 and pull wire 1026. In this way, catheter 1000 may be configured todampen a push force applied to control member 1014 during an activereturn of elongate member 1002. In some examples, the spring also mayprovide for some active straightening. With no spring 1066, the cathetermay function without active straightening.

The catheters described herein may be manufactured using any suitabletechnique. FIG. 11 is a flow diagram illustrating an example method ofmanufacturing an elongate member of a deflectable catheter. Although thetechnique illustrated in FIG. 11 is described in reference to catheter200 illustrated in reference to FIGS. 2A and 2B, the technique may beused to manufacture other catheters, such as catheters 100, 300, 400,500, 600, 700, 800, 900, and/or 1000. Additionally, catheters 100, 200,300, 400, 500, 600, 700, 800, 900, and/or 1000 may be manufactured usingother techniques.

The technique illustrated in FIG. 11 includes forming elongate member202. Forming elongate member may include, for example, forming a corelayer 218 (1102), forming an interior layer, e.g., an inner layer 224(1104), and forming an exterior layer, e.g., an outer layer 226 (1106).Forming elongate member may also include, for example, positioning innerlayer 224 over a mandrel, positioning a sacrificial pull wire on innerlayer 224, positioning a tubular member over the sacrificial pull wireand inner layer 224, positioning core layer 218 over the tubular member,and positioning outer layer 226 over the core layer 218. As discussedabove, inner layer 224 may include any suitable polymer, such as, forexample, polytetrafluoroethylene. As discussed above, outer layer 226may include any suitable polymer, such as, for example, polyether blockamide.

In some examples, positioning core layer 218 may include braiding two ormore metal wires onto a mandrel. In some examples, forming core layer218 may include forming core layer 218 directly over inner layer 224. Insome examples, forming elongate core layer 218 may include abrading orcoating an interior surface of an exterior surface of elongate corelayer 218 prior to depositing inner layer 224 or outer layer 226 on arespective surface.

In some examples, rather than positioning core layer 218 on inner layer224, the technique may include depositing onto interior surface 222 ofcore layer 218 a polymer to form inner layer 224. Any suitabledeposition or coating method may be used to deposit inner layer 224. Insome examples, inner layer 224 may be deposited onto a mandrel prior toforming elongate core layer 218 over inner layer 224. In some examples,pull wire 208 (or a sacrificial wire) may be positioned adjacent tointerior surface 222 of core layer 218 prior to depositing inner layer224 such that inner layer 224 may substantially encase pull wire 208.

In some examples, rather than positioning outer layer 226 over corelayer 218, the technique may include depositing a polymer onto exteriorsurface 220 of core layer 218 to form outer layer 226. Any suitabledeposition or coating method may be used to deposit outer layer 226.Outer layer 226 may at least partially flow into spaces between filarsof core layer 218.

The technique illustrated in FIG. 11 includes overmolding proximalfixation member 206 onto proximal portion 236 of elongate member 202(1108). In some examples, proximal fixation member 206 (e.g., retentionarm 244) may be overmolded to encase at least a portion of pull wire208. In some examples, the technique may include coupling a revealsurround 252 to retention arm 244. In some examples, the technique alsomay include overmolding a hub assembly onto proximal fixation member 206and/or a proximal portion 236 of elongate member 202 thereby encasingthe pull wire 208. In examples in which inner layer 224 is depositedover a sacrificial wire, the technique may include, after overmoldingproximal fixation member 206, and, in some examples, hub assembly 802,replacing the sacrificial wire with pull wire 208. In some examples,after removing the sacrificial wire, e.g., by pulling, a proximal end ofpull wire 208 may be threaded into inner layer 224 at the distal end 212of elongate body 202. In some example, the distal end 232 of pull wire208 may include a bulbous structure that may be anchored to distalfixation member 204.

The technique illustrated in FIG. 11 includes overmolding distalfixation member 204 onto distal portion 230 of elongate member 202(1110). In some examples, distal fixation member 204 may be overmoldedto encase at least a portion of distal end 232 of pull wire 208. In someexamples, before or after overmolding distal fixation member 204, thetechnique may include knotting, looping, and/or welding a bulbousstructure to distal end 232 of pull wire 208. In some examples, thetechnique also may include overmolding a distal cup onto distal fixationmember 204 and/or a distal portion 230 of elongate member 202.

FIG. 12 is a flow diagram illustrating an example method ofmanufacturing a deflectable assembly of a deflectable catheter. Althoughthe technique illustrated in FIG. 12 is described in reference tocatheter 900 illustrated in reference to FIGS. 9A-9F, the technique maybe used to manufacture other catheters, such as catheters 100, 200, 300,400, 500, 600, 700, 800, and/or 1000. Additionally, catheters 100, 300,400, 500, 600, 700, 800, 900, and/or 1000 may be manufactured usingother techniques.

The technique illustrated in FIG. 12 includes coupling hypotube 932 topull wire 926 (1202). For example, pull wire 926 may be positionedwithin a lumen 931 of hypotube 932 and then hypotube 932 may be crimpedto mechanically coupled hypotube 932 to pull wire 926. In otherexamples, pull wire 926 may be adhered to hypotube 932, for example,using an epoxy or another suitable adhesive or welding.

The technique illustrated in FIG. 12 includes coupling control member914 to hypotube 932 (1204). For example, hypotube 932 may bemechanically coupled into a molded fitting defined by control member 914or adhered to control member 914, for example, using an epoxy or anothersuitable adhesive. In examples in which the catheter includes adampening member, the technique may include assembling dampening member1060, coupling inner pull block 1064 to hypotube 1032, and couplingouter pull block 1062 to control member 1014.

The technique illustrated in FIG. 12 includes positioning elongatemember 902 and/or hub assembly 920 on first portion 916 of handle 912(1206). The technique also includes coupling second portion 918 ofhandle 912 to first portion 916 (1208).

The catheters described herein may be used to delivery an implantablemedical device to a target site within a body of a patient. FIG. 13 is aflow diagram illustrating an example method of using a deflectablecatheter. Although the technique illustrated in FIG. 13 is described inreference to catheter 100 illustrated in reference to FIG. 1 , thetechnique may be used with other catheters, such as catheters 200, 300,400, 500, 600, 700, 800, 900, and/or 1000. Additionally, catheters 100,200, 300, 400, 500, 600, 700, 800, 900, and/or 1000 may be used withother techniques.

The technique illustrated in FIG. 13 includes introducing distal portion116 of elongate body 102 of catheter 100 into vasculature of a patient(1302). In some examples, introducing catheter 100 may include creatingan incision in the femoral vein of the patient.

After introducing catheter 100, the technique may include navigatingcatheter 100 to a target chamber of the heart of the patient. In someexamples, navigating may include using fluoroscopy to visualize alocation of catheter 100 relative to an anatomy of the patient.Navigating catheter 100 includes controlling catheter 100 to deflectfrom an initial configuration to a deflected configuration (1304), andcontrolling catheter 100 to actively return from the deflectedconfiguration to the initial configuration (1306). The technique alsomay include deploying an IMD from a distal cup 134 of catheter 100 tothe target location within the vasculature of the patient.

The following clauses illustrate example subject matter describedherein.

Clause 1. A catheter comprising: an elongate member extending from aproximal end to a distal end, wherein the elongate member comprises awall defining a longitudinally extending lumen; a fixation membercoupled to an exterior surface of the wall on a distal portion of theelongate member; and a pull wire extending through the wall of theelongate member from the proximal end of the elongate member to thefixation member, wherein the pull wire is coupled to the fixationmember, and wherein the elongate member is configured to deflect from aninitial configuration to a deflected configuration in response to a pullforce applied to the pull wire.

Clause 2. The catheter of claim 1, wherein the elongate member isfurther configured to deflect from the deflected configuration to theinitial configuration in response to a push force applied to the pullwire.

Clause 3. The catheter of claim 1 or 2, wherein the pull wire extendsfrom the proximal end of the elongate member to the fixation memberthrough at least a portion of the wall of the elongate member.

Clause 4. The catheter of any one of claims 1 through 3, wherein thewall comprises: an elongate core layer defining an exterior surface andan interior surface defining the longitudinally extending lumen; aninner layer disposed on the interior surface of the elongate core layer;and an outer layer disposed on the exterior surface of the elongate corelayer, wherein the pull wire is disposed at least one of between theinner layer and the core layer or through the inner layer.

Clause 5. The catheter of claim 4, wherein the elongate core layercomprises a coiled or braided metal wire.

Clause 6. The catheter of claim 4 or 5, wherein the pull wire protrudesthrough the core layer and the outer layer to an exterior surface of theouter layer at a proximal portion of the elongate member.

Clause 7. The catheter of any one of claims 1 through 6, wherein thefixation member comprises at least one of a ferrule or a colletconfigured to engage the exterior surface of the wall of the elongatemember by at least one of a friction fit, a compression fit, or anovermold and couple to a distal end of the pull wire.

Clause 8. The catheter of any one of claims 1 through 7, wherein adistal end of the pull wire comprises at least one of a bulbousstructure, a loop, a knot, a weld bead, or a washer.

Clause 9. The catheter of any one of claims 1 through 8, wherein adistal end of the catheter comprises a distal cup extending from thefixation member to a distal tip of the distal cup, wherein the distalcup encases at least one of at least a portion of the fixation member orat least a portion of the distal end of the elongate pull wire.

Clause 10. The catheter of claim 9, wherein the elongate membercomprises a first polymer, wherein the distal cup comprises a secondpolymer, and wherein at least one of a tensile strength of the secondpolymer is greater than a tensile strength of the first polymer or aductility of the first polymer is greater than a ductility of the secondpolymer.

Clause 11. The catheter of any one of claims 1 through 10, wherein thefixation member comprises a first fixation member, and the catheterfurther comprises a second fixation member is coupled to an exteriorsurface of the wall on the proximal end of the elongate member.

Clause 12. The catheter of claim 11, wherein the second fixation membercomprises: at least one of a ferrule or a collet configured to engagethe exterior surface of the wall of the elongate member by at least oneof a friction fit or a compression fit; and a channel configured toretain the pull wire in sliding engagement.

Clause 13. The catheter of claim 12, wherein the second fixation memberfurther comprises a retention arm extending from the ferrule or thecollet, the retention arm comprising a retention channel extending froma distal end to a proximal end thereof at an angle away from alongitudinal axis of the elongate member, wherein the retention channelis configured to retain the pull wire in sliding engagement.

Clause 14. The catheter of claim 13, wherein the second fixation memberfurther comprises a reveal surround coupled to the retention arm, thereveal surround comprising a reveal surround channel configured toretain the pull wire in sliding engagement, wherein the reveal surroundchannel extends from a distal end to a proximal end thereof at an angleaway from the longitudinal axis of the elongate member.

Clause 15. The catheter of any one of claims 1 through 14, wherein thecatheter further comprises an overmolded hub assembly encasing at leasta proximal portion of the elongate member.

Clause 16. The catheter of claim 15, wherein the overmolded hub assemblyencases at least a portion of the second fixation member and at least adistal portion of the reveal surround.

Clause 17. A catheter comprising: an elongate member extending from aproximal end to a distal end, wherein the elongate member comprises awall defining a longitudinally extending lumen; a distal fixation membercoupled to an exterior surface of the wall on a distal portion of theelongate member; a proximal fixation member coupled to an exteriorsurface of the wall on a proximal portion of the elongate member; aretention arm integrally formed with the proximal fixation member,wherein the retention arm is configured to retain the pull wire insliding engagement at an angle extending away from a longitudinal axisof the elongate member; and a pull wire extending from a distal endcoupled to the distal fixation member, through the wall of the elongatemember, to a distal portion extending through the proximal fixationmember and retention arm, and wherein the elongate member is configuredto deflect from an initial configuration to a deflected configuration inresponse to a pull force applied to the pull wire.

Clause 18. A method comprising: forming an elongate member extendingfrom a proximal end to a distal end, wherein the elongate membercomprises a wall defining a longitudinally extending lumen; overmoldinga fixation member onto an exterior surface of the wall on a distalportion of the elongate member; and anchoring a pull wire to thefixation member, wherein the pull wire extends through the wall of theelongate member from the proximal end of the elongate member to thefixation member, and wherein the elongate member is configured todeflect from an initial configuration to a deflected configuration inresponse to a pull force applied to the pull wire.

Clause 19. The method of claim 18, wherein forming the elongate membercomprises: positioning the pull wire adjacent to an exterior surface ofan elongate core layer of the elongate member; and forming an outerlayer on an exterior surface of the elongate core layer, wherein thepull wire extends through the outer layer from the proximal end of theelongate member to the fixation member.

Clause 20. The method of claim 18 or 19, wherein anchoring the pull wireto the fixation member comprises at least one of knotting or looping adistal end of the pull wire, welding a bulbous structure to the distalend of the pull wire, or overmolding the fixation member to encase thedistal end of the pull wire.

Clause 21. The method of any one of claims 18 through 20, whereinanchoring the pull wire to the fixation member comprises overmolding adistal cup to onto at least one of a portion of the fixation member, adistal end of the pull wire, or the distal end of the elongate member.

Clause 22. The method of any one of claims 18 through 21, wherein thefixation member comprises a first fixation member, and wherein themethod further comprises overmolding a second fixation member onto anexterior surface of the wall on the proximal end of the elongate memberto encase at least a portion of the pull wire.

Clause 23. The method of claim 22, further comprising: coupling a revealsurround to the second fixation member; and overmolding a hub assemblyonto at least one of a proximal portion of the second fixation member, adistal portion of the reveal surround, or the proximal portion of theelongate member.

Clause 24. The method of any one of claims 18 through 23, wherein theelongate member is configured to deflect from the deflectedconfiguration to the initial configuration in response to a push forceapplied to the pull wire.

Various examples of the disclosure have been described. Any combinationof the described systems, operations, or functions is contemplated.These and other examples are within the scope of the following claims.

What is claimed is:
 1. A catheter comprising: an elongate memberextending from a proximal end to a distal end, wherein the elongatemember comprises a wall defining a longitudinally extending lumen; afirst fixation member coupled to an exterior surface of the wall on adistal portion of the elongate member; a second fixation member coupledto an exterior surface of the wall on the proximal end of the elongatemember; an overmolded hub assembly encasing at least a proximal portionof the elongate member, wherein the overmolded hub assembly encases atleast a portion of the second fixation member and at least a distalportion of a reveal surround; and a pull wire extending through the wallof the elongate member from the proximal end of the elongate member tothe first fixation member, wherein the pull wire is coupled to the firstfixation member, and wherein the elongate member is configured todeflect from an initial configuration to a deflected configuration inresponse to a pull force applied to the pull wire.
 2. The catheter ofclaim 1, wherein the elongate member is further configured to deflectfrom the deflected configuration to the initial configuration inresponse to a push force applied to the pull wire.
 3. The catheter ofclaim 1, wherein the pull wire extends from the proximal end of theelongate member to the first fixation member through at least a portionof the wall of the elongate member.
 4. The catheter of claim 1, whereinthe wall comprises: an elongate core layer defining an exterior surfaceand an interior surface defining the longitudinally extending lumen; aninner layer disposed on the interior surface of the elongate core layer;and an outer layer disposed on the exterior surface of the elongate corelayer, wherein the pull wire is disposed between the inner layer and thecore layer, through the inner layer, or both.
 5. The catheter of claim4, wherein the elongate core layer comprises a coiled or braided metalwire.
 6. The catheter of claim 4, wherein the pull wire protrudesthrough the core layer and the outer layer to an exterior surface of theouter layer at the proximal portion of the elongate member.
 7. Thecatheter of claim 1, wherein the first fixation member comprises aferrule or a collet configured to: engage the exterior surface of thewall of the elongate member by at least one selected from a group of afriction fit, a compression fit, and an overmold; and couple to a distalend of the pull wire.
 8. The catheter of claim 1, wherein a distal endof the pull wire comprises at least one selected from a group of abulbous structure, a loop, a knot, a weld bead, and a washer.
 9. Thecatheter of claim 1, wherein a distal end of the catheter comprises adistal cup extending from the first fixation member to a distal tip ofthe distal cup, wherein the distal cup encases at least a portion of thefirst fixation member, at least a portion of a distal end of the pullwire, or both.
 10. The catheter of claim 9, wherein the elongate membercomprises a first polymer, wherein the distal cup comprises a secondpolymer, and wherein a tensile strength of the second polymer is greaterthan a tensile strength of the first polymer, a ductility of the firstpolymer is greater than a ductility of the second polymer, or both. 11.The catheter of claim 1, wherein the second fixation member comprises: aferrule or a collet configured to engage the exterior surface of thewall of the elongate member by a friction fit, a compression fit, orboth; and a channel configured to retain the pull wire in slidingengagement.
 12. The catheter of claim 11, wherein the second fixationmember further comprises a retention arm extending from the ferrule orthe collet, the retention arm comprising a retention channel extendingfrom a distal end to a proximal end thereof at an angle away from alongitudinal axis of the elongate member, wherein the retention channelis configured to retain the pull wire in sliding engagement.
 13. Thecatheter of claim 12, wherein the second fixation member furthercomprises a reveal surround coupled to the retention arm, the revealsurround comprising a reveal surround channel configured to retain thepull wire in sliding engagement, wherein the reveal surround channelextends from a distal end to a proximal end thereof at an angle awayfrom the longitudinal axis of the elongate member.
 14. A cathetercomprising: an elongate member extending from a proximal end to a distalend, wherein the elongate member comprises a wall defining alongitudinally extending lumen; a distal fixation member coupled to anexterior surface of the wall on a distal portion of the elongate member;a proximal fixation member coupled to an exterior surface of the wall ona proximal portion of the elongate member; an overmolded hub assemblyencasing at least the proximal portion of the elongate member, whereinthe overmolded hub assembly encases at least a portion of the proximalfixation member and at least a distal portion of a reveal surround; aretention arm integrally formed with the proximal fixation member,wherein the retention arm is configured to retain a pull wire in slidingengagement at an angle extending away from a longitudinal axis of theelongate member; and the pull wire extending from a distal end to aproximal end, wherein the distal end of the pull wire is coupled to thedistal fixation member, wherein the pull wire extends through the wallof the elongate member, the proximal fixation member,. and the retentionarm, and wherein the elongate member is configured to deflect from aninitial configuration to a deflected configuration in response to a pullforce applied to the pull wire.
 15. A catheter comprising: an elongatemember extending from a proximal end to a distal end, wherein theelongate member comprises a wall defining a longitudinally extendinglumen; a first fixation member coupled to an exterior surface of thewall on a distal portion of the elongate member; a second fixationmember coupled to an exterior surface of the wall on the proximal end ofthe elongate member, wherein the second fixation member comprises: aferrule or a collet configured to engage the exterior surface of thewall of the elongate member by a friction fit, a compression fit, orboth; a channel configured to retain a pull wire in sliding engagement;a retention arm extending from the ferrule or the collet, the retentionarm comprising a retention channel extending from a distal end to aproximal end thereof at an angle away from a longitudinal axis of theelongate member, wherein the retention channel is configured to retainthe pull wire in sliding engagement; and a reveal surround coupled tothe retention arm, the reveal surround comprising a reveal surroundchannel configured to retain the pull wire in sliding engagement,wherein the reveal surround channel extends from a distal end to aproximal end thereof at an angle away from the longitudinal axis of theelongate member; and the pull wire extending through the wall of theelongate member from the proximal end of the elongate member to thefirst fixation member, wherein the pull wire is coupled to the firstfixation member, and wherein the elongate member is configured todeflect from an initial configuration to a deflected configuration inresponse to a pull force applied to the pull wire.
 16. The catheter ofclaim 15, wherein the elongate member is further configured to deflectfrom the deflected configuration to the initial configuration inresponse to a push force applied to the pull wire.
 17. The catheter ofclaim 16, wherein the pull wire extends from the proximal end of theelongate member to the first fixation member through at least a portionof the wall of the elongate member.
 18. The catheter of claim 15,wherein the wall comprises: an elongate core layer defining an exteriorsurface and an interior surface defining the longitudinally extendinglumen; an inner layer disposed on the interior surface of the elongatecore layer; and an outer layer disposed on the exterior surface of theelongate core layer, wherein the pull wire is disposed between the innerlayer and the core layer, through the inner layer, or both.